In the latest episode of the Genetics Society’s ‘Genetics Unzipped’ podcast, sponsored by Thermo Fisher Scientific, Geneticist Dr Kat Arney looks at how genomic technologies are transforming cancer care and the importance of making sure that these advances are available to all.
From Mutations to Moonshots
In recent years we’ve seen huge advances in the way that we think about cancer and the way that we treat it. Rather than putting patients into broad ‘buckets’ – bowel cancer, breast cancer and so on – we’re moving towards a more sophisticated view of each individual person’s disease, driven by increasing knowledge of the genetic and molecular faults that underpin their unique disease, and selecting more personalised treatments that should have a better chance of working.
Greg Simon, past president of the Biden Cancer Initiative and former executive director of the White House Cancer Moonshot Task Force under President Obama and vice-president Biden, shares his thoughts on where we’ve come in terms of precision medicine for cancer and where we’re heading in the future
“There’s no doubt that drugs that activate the immune system are the bright, shiny yellow object. There’s no doubt about that. And for good reason – cutting burning and radiating through surgery, chemo and radiation can not be the future of cancer – should not be.”
Greg has personal experience of cancer treatment:
“I have leukaemia. I had chemotherapy. With my particular leukaemia (CLL) nobody gets chemotherapy now and I was treated only four years ago. So now they all get a pill, no more chemo, which is great because it’s a chronic condition, I’ll probably get it again and I’ll take a pill instead of chemo three days a month. So that’s progress. But the other thing is when you activate the immune system, it is a beast. And what you don’t know is, is it your beast or is it not your beast? And if we activate the immune system, it’s hard to shut it down.”
But activating our own immune systems against cancer is a dangerous game…:
“So you could get diabetes, you could get MS. You can get all kinds of autoimmune diseases and cancer, right? So we have to be, you have to be careful. Most people would trade diabetes for cancer, but they don’t want to add it to cancer. So I think we will be dealing with the immune system now for a long, long time.”
Progress in Childhood Cancers
Most of the focus on cancer research is aimed at adults. However, given that September is Childhood Cancer Awareness Month, it’s especially important to think of the children.
While cancers in children are mercifully rare, around 1,400 kids are diagnosed with cancer every year in the UK. And although survival is arguably now very good, with more than 8 in ten surviving for at least five years on average, it’s not good enough. And, of course, these survival rate statistics are from a wealthy country with all the advantages of modern medicine.
Jim Downing – president and CEO of St Jude Children’s Research Hospital, one of the leading US centres for research and treatment of childhood cancers – shares his thoughts on how far we’ve come in treating children with cancer and where we need to get to in the future.
“So now we have a world where paediatric cancer is going to be increasing because kids are going to be living to that one to 15 year of age and not dying in that first year. We have healthcare systems that don’t even know how to treat these children and aren’t ready to treat these children. And if one looks at the economic impact in a country, you know, for life adjusted years, you’re talking about a major economic impact because if you can cure them and we know we can cure 80% of them, that’s the rest of their life that they can contribute to that economy.”
So if cancer in children is going to be a growing issue what should we do?
“So, you know, how does one address that? How does one raise those cure rates, raise the infrastructure needed to treat children with cancer. And you can go country by country or region by region, but wouldn’t it be better to pull everyone together and to really develop a global alliance where we can learn across the world at the same time, what works, what doesn’t work, what did we learn from this culture that we might be able to transfer into this part? What are those experiments of nature that will give us new insights into cancer? Can we look at particular genetic subtypes of cancer in low and middle income countries where they won’t be able to be treated as aggressively as they are in developed countries? And do they actually do as well? And are we over-treating in developed countries?”
Jim believes such an alliance would be a win-win for everyone:
So I like to say, if we organize this and we developed this global alliance, we will learn more from low and middle income countries than they will learn from us. Bringing everyone together, we can accelerate progress so that one day no child does die in the dawn of life from cancer.”
Dr Marianne Grantham is the Head of Cytogenetics and Molecular Haematology department at the Royal London Hospital, at Barts Health NHS Trust. She and her colleagues are tasked with testing many thousands of samples every year from patients in London and the Southeast of England with blood cancers – or haematological malignancies, to give them their scientific name – as well as solid tumours such as bowel, breast or lung cancers. This could be to confirm a new diagnosis, to help doctors select the best treatment, or to see how their disease is responding to therapy. But how have the technologies available to her changed things in recent years?
Marianne; “Things used to take a really long time and you know, we would be turning around results in sort of a month or so. Partly because the results that we were looking for at that time, didn’t have the same impact on patient management that they do today. And obviously as you can, well, imagine everybody wants things as quickly as possible. And certainly for patients themselves, the period of, of, of sitting and waiting to determine what’s going to happen can be hugely distressing. So the sooner we can give people our clinicians and our patients an answer and a definitive treatment plan the better.”
On To the Next Generation
As Marianne says, time is of the essence when it comes to the journey from a patient’s cancer sample to an actionable report on their doctor’s desk. We’ve certainly come a long way from the days when it would take months to genetically analyse a tumour sample, but when it comes to treating cancer, every day counts.
Kim Wood from Thermo Fisher Scientific’s Clinical Sequencing Division is working on next generation sequencing and the technologies that can be used by pathology labs to analyse tumour samples and help doctors decide on the best course of action.
Right now their latest sequencing machine, Ion Torrent Genexus, is still being put through its paces in research settings – meaning that it’s currently designated for research use only – but exciting plans are under way to get it approved for routine medical use in Europe and the UK within the next few years.
“In context of a previous systems that have been on the market, that the quickest time period that we’ve seen for next generation sequencing systems has been four days, but routinely up to two weeks. The Genexus integrated sequencer provides a sample to report within 24 hours.
We’ve also worked really, really hard to make the, all of our systems are solution based system and for it to be as user friendly as possible. So that includes not only providing the technology, but assays as well and what this system generates is not just a bunch of raw data. That’s meaningless. It actually, we provide the tools that are needed to make sense of that data and to slim down that data into something that’s meaningful.”
For Kim it’s also a personal journey:
“I’ve recently witnessed my mom being diagnosed with cancer. She had treatment and then she relapsed. And everybody’s experience with cancer is different, but for my family, the most agonizing time was waiting for the results. And during this time we just realized just how impactful this paradigm shift of precision medicine and precision oncology has to change the outcomes of cancer patients in the future. And I can honestly say that during that time of realizing that she’d relapsed with cancer before we could get to “these are the test results, this is the plan, this is the way we’re going to move forward with the treatment, and this is the backup plan” – that for me, was the most agonizing period that we’ve been through, actually more so than the treatment itself.
And so for me, anything that can provide or facilitate a step change in precision oncology and also speed up that result and accessibility to the most comprehensive genomic profiling to give the most actionable results in a short time period, from a personal opinion, that’s for me is the most exciting thing.”
Meet the monkey flower
And don’t forget to check out the latest episode of the podcast from Heredity, the journal of The Genetics Society. This week, they’re exploring the issue of ‘plant blindness’: the unfortunate tendency of biologists to overlook the research value and potential of plants. You can find the full interview in the latest Heredity podcast – just search for Heredity in your favourite podcast app, or follow the link on the page for this podcast at Geneticsunzipped.com.
Full show notes, transcript, music credits and references online at GeneticsUnzipped.com.
Genetics Unzipped is the podcast from the UK Genetics Society, presented by award-winning science communicator and biologist Kat Arney and produced by First Create the Media. Follow Kat on Twitter @Kat_Arney, Genetics Unzipped @geneticsunzip, and the Genetics Society at @GenSocUK